13 May 2014

Call the midwives – NHS watchdog wants more home births

An NHS watchdog encourages healthy women to give birth at home or in midwife-led wards – having previously urged caution over such births. But with a shortage of midwives, is this guidance feasible?

The National Institute for Health and Care Excellence (Nice) published draft guidance on Tuesday saying that home birth could be as safe as hospital for low-risk pregnant women who have already had at least one child.

Home births are just as safe as other settings for low risk pregnant women. Christine Carson, Nice

The organisation said new evidence had come to light saying that home births are just as safe as other settings for women who have already given birth – though not for women expecting their first child.

Christine Carson, clinical guideline programme director for Nice, said: “We now know that these (midwife-led) units are as safe as traditional labour wards for all ‘low-risk’ pregnant women and are more likely to result in a better birth experience with less medical intervention.

“The evidence also highlights that home births are just as safe as other settings for low risk pregnant women who already have at least one child, but not for women expecting their first baby.

“However, every woman should ultimately have the freedom to choose where she wants to give birth and be supported in her choice.”


As well as Nice’s stated reasons for the change in guidance, the approach could also result in significant financial savings for the NHS.

Births in traditional hospital wards are the most expensive option for the NHS. The birthplace research programme has found that each birth in an obstetric unit coasts £1,631, compared with £1,431 in a midwife-led unit attached to a hospital, £1,435 for a freestanding midwife-led unit, and £1,067 for a home birth.

In 2012 there were 729,000 live births in England and Wales, Nice said – an increase of 20 per cent over the last decade. Maternity care costs the NHS £2.6bn annually.

However, concerns have been raised over whether or not these proposals can be implemented considering that there is already a lack of midwives in the NHS.

Cathy Warwick, chief executive of the Royal College of Midwives, welcomed the guidance – saying that births in midwife-led units or at home “may be safer than hospital”.


However, she added that there needs to be more investment in midwifery.

“There… has to be more investment in midwife-led care, in midwife-led units and in home births,” she said. “Additionally, we need to ensure that midwives being trained get jobs when they qualify so that we have the right number of midwives to deliver these services.

“It is then that a choice that exists in theory will become a choice that exists in reality for all women.”

MPs sitting on the public accounts committee recently criticised the government’s approach to midwifery – saying there is a shortage of 2,300 midwives in the NHS.

The committee also said that though the number of midwife-led units has risen from 87 in 2007 to 152 in 2013, and though research suggests only a quarter of women want to give birth in a hospital obstetric unit, 87 per cent of women gave birth on obstetric wards in 2012.